MEDICARE: JACK CHRISTIAN WINTERS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2088F0040X	Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician	MD.019976	LA
2	208800000X	Urology Physician	MD.019976	LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	5W2047627	OTHER	LA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194756999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACK CHRISTIAN WINTERS M.D.

Provider Business Mailing Address
First Line	:	5215 ESSEN LN STE 200
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-3543
Country	:	US
Telephone Number	:	225-215-1281
Fax Number	:	225-215-1380

Provider Business Practice Location Address
First Line	:	2800 VETERANS MEMORIAL BLVD STE 140
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70002-6139
Country	:	US
Telephone Number	:	504-584-6990
Fax Number	:	504-584-6980

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	02/10/2026

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